Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in chronic poor metabolic control: a randomized controlled trial

OBJECTIVE — The aim of this study was to determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could improve adherence and metabolic con-trol and decrease rates of hospital utilization among adolescents with chronically poorly con-trolled type 1 diabetes. RESEARCH DESIGN AND METHODS — A randomized controlled trial was con-ducted with 127 adolescents with type 1 diabetes and chronically poor metabolic control (HbA1c [A1C]8 % for the past year) who received their diabetes care in a children’s hospital located in a major Midwestern city. Participants randomly assigned to MST received treatment for 6 months. Data were collected at baseline and at 7 months posttest (i.e., treatment termination). Changes in A1C adherence, as measured by semistructured interviews and blood glucose meters and hospital admissions and emergency department visits, were assessed. RESULTS — In intent-to-treat analyses, participation in MST was associated with significant improvements in the frequency of blood glucose testing as assessed by blood glucose meter readings (F[1,125] 16.75, P 0.001) and 24-h recall interviews (F[1,125] 6.70, P 0.011). Participants in MST also had a decreasing number of inpatient admissions, whereas th